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Types of Vertigo

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) occurs after a sudden movement of the head. It is one of the most common types of vertigo (Crespi 2004). Women are affected twice as often as men, and the average age of onset is the mid-50s (Salvenelli 2004).

BPPV is usually harmless and often no cause is detected (ie, idiopathic). In some cases, however, BPPV is caused by age-related degeneration or head trauma (Gordon 2002). Patients with BPPV have short-lived episodes of temporary dizziness, lightheadedness, imbalance, and nausea. Symptoms of BPPV, which usually develop suddenly after a change in head position, may be severe enough to cause vomiting (Goplen 2002). Typical motions that cause episodes of BPPV include getting out of bed, rolling over, bending down, and looking up while standing (Bertholon 2002). One of the characteristic symptoms of BPPV is rapid movement of the eye in one direction followed by a slow drift back to its original position. This involuntary movement of the eyes is a type of nystagmus. Doctors can sometimes tell what kind of vertigo is present by the nature of the nystagmus.

BPPV occurs when debris from the otoliths settles into the posterior semicircular canal. This renders the canal oversensitive to the pull of gravity, producing a constant sense of motion or falling (Parnes 2003).

Ménière’s Syndrome and Ménière’s Disease

The terms Ménière’s disease and Ménière’s syndrome are sometimes used interchangeably. However, even though both involve the inner ear apparatus, they are not the same disorder. Ménière’s disease develops due to idiopathic (or unknown) causes, while Ménière’s syndrome is secondary to other diseases such as inner ear inflammation caused by syphilis, thyroid disease, or head trauma. Of the two, the most common is idiopathic Ménière’s disease.

Ménière’s of either variety is recognized by a classic triad of symptoms: vertigo; low-frequency, fluctuating hearing loss; and tinnitus (ringing in the ears) (da Costa 2002). Also, the condition is characterized by a condition known as endolymphatic hydrops, or increased hydraulic pressure in the inner ear's endolymphatic system. Although researchers have long suspected that endolymphatic hydrops was the underlying cause of the symptoms of Ménière’s disease, newer studies have called into question an even deeper cause. The endolymphatic hydrops in Ménière’s disease may be caused by neurotoxicity and progressive damage to the cochlear nerve in the ear; the increased pressure is a result rather than a cause (Megerian 2005; Semaan 2005). Some early research has suggested that nerve cell toxicity is mediated by nitric oxide, which is an important mediator in the inflammatory process. This suggests that agents that block nitric oxide may someday be important in the treatment of Ménière’s (Megerian 2005; Takumida 2001).

In the meantime, while researchers are still pursuing these findings, other treatments may come to the forefront. For instance, because people with Ménière’s disease have been shown to have characteristic abnormalities in their inner ear and an elevated level of free radicals (Raponi 2003), free radical scavengers may be of benefit in treating Ménière’s.

People who have Ménière’s may experience attacks of vertigo that last 1 to 8 hours. These attacks (and the accompanying tinnitus) can be severe. There may also be an aura (such as a sensation of seeing lights or smelling odors). These symptoms may last an indefinite period. In the worst cases, hearing loss is permanent (de Sousa 2002).

Other types of vertigo include:

  • Vestibular neuronitis involves an attack of vertigo that occurs without accompanying disruption of hearing. Its symptoms may persist for up to several weeks before clearing, but usually abate within a matter of days. It is sometimes referred to as vestibular neuropathy (El-Kashlan 2000).
  • Labyrinthitis is an acute inflammation of the labyrinths, often caused by viral infections, although it can also be caused by reactions to medications or toxins. People with labyrinthitis experience an acute onset of severe vertigo that lasts several days to a week. It is typically accompanied by hearing loss and tinnitus.
  • Phobic postural vertigo is the second most common diagnosis in people with dizziness or vertigo, although there is some debate about whether this is a single disorder or represents a group of different conditions with possible different causes (Eckhardt-Henn 1997). Phobic postural vertigo, which is characterized by nonrotational vertigo with postural and gait instability, mainly occurs in people with an obsessive-compulsive personality (Dieterich 2000).
  • Migraine-associated vertigo is a disorder that can accompany a migraine headache. In medical practices focused on treating migraine, 27 to 42% of patients report episodic vertigo. A large number (about 36%) of these patients also experienced vertigo during headache-free periods (Bir 2003).
  • Posttraumatic vertigo immediately follows head trauma. In most cases, it causes damage to the inner ear mechanisms in the absence of other central nervous system signs. The interval between injury and onset of symptoms can be days or even weeks. The mechanism for the delay of symptoms is uncertain but includes hemorrhage into the labyrinth, with later development of labyrinthitis in the fluids of the inner ear (Ernst 2005).
  • Central nervous system dysfunction causes of vertigo are varied and include brainstem vascular disease, arteriovenous malformation, tumor of the brainstem and cerebellum, multiple sclerosis, and vertebrobasilar migraine (Baloh 2002).